Journal article
The Incidence of Right Upper-Lobe Collapse When Comparing a Right-Sided Double-Lumen Tube Versus a Modified Left Double-Lumen Tube for Left-Sided Thoracic Surgery
Anesthesia and analgesia, Vol.90(3), pp.535-540
03/2000
DOI: 10.1097/00000539-200003000-00007
PMID: 10702432
Abstract
Lung deflation for left-sided thoracic surgery can be accomplished by using either a left- or right-sided double-lumen endotracheal tube (L-DLT or R-DLT). Anatomic variability of the right mainstem bronchus and the possibility of right upper-lobe obstruction have discouraged the routine use of R-DLT. There are, however, situations in which it is preferable to avoid manipulation/intubation of the left main bronchus, requiring placement of a R-DLT. We compared the modified L-DLT with the R-DLT to determine whether R-DLTs can be used during left-sided thoracic surgery without an increased risk of right upper-lobe collapse. Forty patients requiring left lung deflation were randomly assigned to one of two groups. Twenty patients received a modified L-DLT BronchoCath((R)) (Mallinckrodt Medical Inc., St. Louis, MO), and 20 received a R-DLT BronchoCath((R)). The following variables were studied: 1) time required to position each tube until satisfactory placement was achieved; 2) number of times fiberoptic bronchoscopy was required to readjust tube position; 3) number of malpositions after initial tube placement; 4) time required for left lung collapse; 5) incidence of right upper-lobe collapse from an intraoperative chest radiograph obtained in a lateral decubitus position; 6) overall surgical exposure; and 7) tube acquisition cost. Median time required for initial tube placement was greater in the R-DLT group (3.4 min) versus the L-DLT (2.1 min); P = 0.04. Overall tube cost was also larger for the R-DLT group (US $1819.40) versus the L-DLT group (US $1107.75). The incidence of malpositions, (five versus two), need for fiberoptic bronchoscopy, time for adequacy of left lung collapse, and incidence of intraoperative right upper-lobe collapse (0) did not significantly differ between R-DLT and L-DLT groups. We conclude that R-DLTs can be used for left-sided thoracic surgery without an increased risk of right upper-lobe collapse. Our data suggest that R-DLTs may be more prone to intraoperative dislodgment/malposition than L-DLTs; however, in all cases, correction of malposition was easily achieved.
Implications: In this study, right-sided double-lumen tubes (R-DLTs) were compared with modified left-sided double-lumen tubes in patients requiring one-lung ventilation for left-sided thoracic surgery. The incidence of right upper-lobe collapse was assessed intraoperatively by a chest radiograph which showed no collapse of the right upper lobe in all patients who received R-DLTs or left-sided double-lumen tubes. Therefore, we conclude that R-DLTs present no increased risk of complications for left-sided thoracic surgery and should not be abandoned.
Details
- Title: Subtitle
- The Incidence of Right Upper-Lobe Collapse When Comparing a Right-Sided Double-Lumen Tube Versus a Modified Left Double-Lumen Tube for Left-Sided Thoracic Surgery
- Creators
- Javier H CamposF. Christopher MassaKemp H Kernstine
- Resource Type
- Journal article
- Publication Details
- Anesthesia and analgesia, Vol.90(3), pp.535-540
- DOI
- 10.1097/00000539-200003000-00007
- PMID
- 10702432
- ISSN
- 0003-2999
- eISSN
- 1526-7598
- Language
- English
- Date published
- 03/2000
- Academic Unit
- Anesthesia
- Record Identifier
- 9984006308502771
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